The spleen is the most frequently injured organ following abdominal trauma, often leading to significant hemorrhage if not quickly diagnosed and treated1. Over time, new treatment strategies for blunt splenic injuries (BSI) have emerged, such as angioembolisation, broadening spleen preservation possibilities even in hemodynamically unstable patients2. However, clinical examination and vital signs alone are insufficient to adequately guide BSI management, and further discriminatory tests are required3.
This study evaluates the predictive value of base deficit (BD)4 in managing BSI to improve emergency department decision-making.
After reviewing 175 cases managed at the Royal Adelaide Hospital (RAH), our findings indicate a significant inverse correlation between BD and the need for surgical intervention. Regression analysis revealed this inverse correlation to be characterised by an OR of 0.8, suggesting that an increase of one unit in BD decreased the likelihood of surgery by 20%.
Based on these findings linking BD and surgery, two BD thresholds were proposed as clinically useful: an “exclusion” threshold of -3.7 with high sensitivity (100%) to theoretically “rule out” the requirement for open surgery, and a threshold for identifying high-risk patients for surgery of -5.6 with balanced sensitivity (80%) and specificity (83%). These thresholds surpass other markers of hemorrhagic shock, such as lactate and the Shock Index, with BD showing superior discriminative power (AUC = 0.90).
These results suggest that BD could become a robust predictor of the need for open surgical intervention in BSI, offering an opportunity for early risk stratification and resource management optimisation. Further investigation is required to confirm these findings.